摘要：
目的 总结手术治疗侵犯气管并需行喉全切除术的颈段或颈胸段食管癌的经验.方法 回顾性分析2004-2011年手术治疗的侵犯气管并需行全喉切除、气管永久造口术的10例颈段或颈胸段食管癌患者的病例资料.根据气管受累情况将患者分为2组,病变仅累及颈段气管(简称颈组,5例),病变累及颈胸段气管(简称胸组,5例).胸组患者开胸切除病变,并行前纵隔气管造口术.对手术方式、术后并发症、术后病理、患者预后等进行分析.结果 10例患者术后随访6～76个月,中位随访时间23个月.颈组中3例患者已无瘤存活5年以上,2例死亡患者中1例于术后14个月死于局部复发,1例于术后26个月死于心肌梗死;胸组2例死于围手术期,术后存活的3例中1例于术后16个月死于局部复发,2例于术后6个月、20个月死于远处转移.结论 侵犯气管并非颈段或颈胸段食管癌的手术禁忌证.对于只有颈段气管受累的患者,根治性手术效果良好,应积极手术治疗,术后应辅以放疗.对于胸段气管亦受累的病例,尤其是气管残端小于5 cm者,手术应慎重.%Objective To evaluate the surgical treatment and outcome of cervicothoracic esophageal carcinoma with tracheal.Methods Ten cases of cervicothoracic esophageal carcinoma with tracheal invasion underwent surgical treatment between 2004 and 2011 was reviewed.Operative methods,complications,pathology,and prognosis were analyzed.Results The patients were divided into 2 groups,5 patients with cervical tracheal invasion group and 5 patients with cervicothoracic tracheal invasion.Thoracotomy and anterior mediastinal tracheostomy (AMT) were required for 5 patients with cervicothoracic tracheal invasion.The median follow-up was 23 months (ranging from 6 to 76 months).Of 5 patients with cervical tracheal invasion,3 patients survived with free of disease for more than 5 years postoperatively,1 patient died of local recurrence at 14 months postoperatively,and 1 patient died of cardiac infarction at 26 months postoperatively.Among 5 patients with cervicothoracic tracheal invasion,2 patients died during hospitalization,and 1 patient died of local recurrence at 16 months postoperatively,and 2 patients died of distant metastasis at 6 and 20 months after surgery respectively.Conclusions Tracheal invasion is not a contraindication to radical operation for the cervicothoracic esophageal carcinoma.Surgical treatment has a good outcome in cervicothoracic esophageal carcinoma with only cervical tracheal invasion.If thoracic trachea is involved,especially when the length of the distal trachea is less than 5 cm,operation should be performed with caution.
